POS0240 WHICH FACTORS DRIVE THE CHOICE BETWEEN A 1ST AND 2ND GENERATION tsDMARD THERAPY IN RA THERAPY?
Authors: D. De Cock, P. Durez, V. Badot, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2022)

Background Tofacitinib and Baricitinib are Janus Kinase Inhibitors (JAKi) considered first generation targeted synthetic DMARD (tsDMARDs) for the treatment of Rheumatoid Arthritis (RA). The second generation of JAKi (Upadacitinib and Filgotinib) seem to target JAK1 more selectively. Choice of JAKi is left to the treating rheumatologist as no head-to head-study or guidelines exist on this choice in RA. Objectives To investigate differences in demographics and clinical variables of patients with RA receiving either a 1 st or a 2 nd generation JAKi in daily practice. Methods Patients were included from the electronic platform “Tool for Administrative Reimbursement Drug Information Sharing” (TARDIS). Data from all Belgian RA patients on biologic (b) and tsDMARDs are here collected for drug reimbursement. Patients were selected for this analysis if starting a JAKi in 2021. Differences in demographic and clinical data were compared by χ 2 -tests and t-tests. Stepwise logistic regression models with tsDMARD choice as dependent variable was constructed with variables with p&lt;0.05 in univariate analyses. Sensitivity analyses for bionaïve and bioexperienced patients were performed. Results In total, 1643 patients with RA starting JAKi therapy in 2021 were included. Of these, 433 (26.4%) were 1 s generation and 1210 (73.6%) were 2 nd generation. Patients starting a 1 st generation JAKi were older, had higher Health Assessment Questionnaire (HAQ) scores, had a higher erythrocyte sedimentation rate (ESR), and less patients starting a 1 st generation JAKi were bioexperienced (Table 1). Table 1. Comparison of baseline demographic and clinical characteristics between 1 st and 2 nd generation tsDMARDs All population Bionaïve patients Bioexperienced patients 1 st generation tsDMARDs 2 nd generation tsDMARDs 1 st generation tsDMARDs 2 nd generation tsDMARDs 1 st generation tsDMARDs 2 nd generation tsDMARDs number 433 1210 207 482 226 728 Age (years) 60.8 ± 12.6* 57.5 ± 13.1* 60.5 ± 12.5* 57.9 ± 13.5* 60.8 ± 12.8* 57.2 ± 12.7* Gender (women) 304 (72.6%) 833 (74.6%) 137 (66.2%) 344 (71.4%) 175 (77.4%) 550 (75.6%) Weight (kg) 73.3 ± 15.3 74.2 ± 15.3 74.7 ± 16.4 74.2 ± 14.4 72.4 ± 13.8 74.6 ± 16.1 Disease duration (years) 9.0 ± 8.9 10.0 ± 9.7 5.6 ± 6.6 5.7 ± 7.1 11.9 ± 9.7 12.5 ± 10.1 HAQ (0-3) 1.9 ± 0.6* 1.3 ± 0.8* 1.8 ± 0.7 1.4 ± 0.7 1.9 ± 0.5* 1.2 ± 0.8* PGA (0-100) 63.5 ± 19.2 63.0 ± 21.5 65.0 ± 17.6 66.0 ± 20.1 62.0 ± 21.0 61.0 ± 21.8 CRP (mg/l) 12.8 ± 11.0 11.7 ± 10.7 16.3 ± 19.5 13.3 ± 15.4 10.5 ± 16.0 10.1 ± 13.5 ESR (mm/h) 25.3 ± 20.1* 22.5 ± 18.3* 28.1 ± 20.2* 23.7 ± 17.5* 21.9 ± 19.3 21.4 ± 19.3 TJC28 8.8 ± 5.5 8.4 ± 5.7 8.7 ± 5.2 9.4 ± 5.4 8.9 ± 5.9* 7.7 ± 5.8* SJC28 6.1 ± 4.6 5.9 ± 4.6 6.1 ± 4.1 6.6 ± 4.1 6.1 ± 4.9 5.5 ± 4.8 DAS28 4.8 ± 1.0 4.7 ± 1.1 5.0 ± 0.9 5.0 ± 4.9 4.7 ± 1.1* 4.5 ± 1.2* Bio-Experienced (yes) 226 (51.1%) * 728 (60.2%) * - - - - N previous b/tsDMARDs 2.0 ± 1.9* 2.3 ± 2.2* - - 2.8 ± 1.0* 3.1 ± 1.4* Number given are mean ± SD or number, proportion. b=biologic; ts= targeted synthetic, HAQ= health assessment questionnaire, PGA= Patient Global assessment; CRP= C-reactive protein; ESR= erythrocyte sedimentation rate; TJC= tender joint count; SJC= Swollen joint Count; DAS28 = disease activity score based on the 28joints; N= number. * Signifies p&lt;0.05. The final logistic regression model included older age (OR(95%) =1.0(1.0-1.0)) and number of previous b/ts DMARDs ((OR(95%) =0.9(0.8-0.9))) as predictors of choice of 1 st generation tsDMARDs (Table 2). In bionaive patients, only ESR (OR(95%) =1.0(1.0-1.0)) was predictive. In bioexperienced patients, older age (OR(95%) =1.0(1.0-1.0)), number of previous b/ts DMARDs ((OR(95%) =0.8(0.7-0.9)) and TJC (OR(95%) =1.0(1.0-1.1)) were predictors for choice of 1 st generation tsDMARDs. HAQ was not included as it was missing in 90% of patients. Conclusion The high uptake of 2 nd generation JAKi, just launched in 2021, is remarkable. Some variables effecting the choice of JAKi were found, yet these effects seemed to be small-sized. These drug choices could also be driven by other factors such as socio-economic status, illness perceptions or other patient reported outcomes, and also by marketing and sales. Disclosure of Interests None declared